金伯华教授学术思想与临床经验及金氏针法治疗强直性脊柱炎肾虚督寒证的临床研究

发布时间：2018-07-03 12:00

本文选题：金伯华 + “金氏针法要论”　；参考：《北京中医药大学》2016年博士论文

【摘要】：本文是本学生跟师金伯华教授学习三年来,对金老学术思想、临床经验较系统的学习总结。主要包含四方面内容：金伯华教授学术思想渊源、金伯华教授学术思想概述、金伯华教授诊疗经验、金氏华佗夹脊督脉温针灸治疗强直性脊柱炎肾虚督寒证的临床研究。1金伯华教授学术渊源金伯华教授学术思想形成,主要包括(1)参军学医,抗美援朝：华北军政大学白求恩医校学习和朝鲜战场战伤抢救,打下了坚实的西医基础；(2)中医之路,名家熏陶：通过第二中医门诊部和北京中医医院学习工作,吸取金针王乐亭、贺普仁、夏寿人等针灸名家学术精华；(3)精研典籍,风格独特：通过中医经典大专班和四部经典著作研究班学习,精读《黄帝内经》、《伤寒论》、《针灸大成》等中医典籍,形成自己风格独特的针、灸、药并用的临床诊疗思路和金氏针法操作技法。(4)中西结合,攻克疑难：主持北京市科委“八五攻关规划——中药研制‘追风速’注射液穴位注射及针灸治疗类风湿性关节炎”研究,取得国家专利。项目研究报告、学术论文获“北京市卫生局科技成果奖”及世界传统医学“生命力杯”奖。2金伯华教授学术思想概述结合金老《金氏针灸临床精粹》、《金伯华痹证治验集》、《针坛巾帼金伯华》等专著,根据金伯华教授针灸方要理论及临床跟师所得,深化和升华金老学术观点,创新性的总结提出由：“治病求源、病多气郁”,“诊法独到、观察入微”,“以调为要、心肾为纲”,“针药并用、相得益彰”,“善用单穴、手针治痛”,“刺法手法、自成一家”等六方面要素组成的“金氏针法要论”。2.1以《内经》理论为指导,临证必谨守中医整体观念、辨证施治之基本大法,治病必求其源。强调对疑难杂症须追根溯源,认为气郁致病为当今主要病机。2.2诊断方法独到,注重经络局部诊察,如中风病人,观舌下系带两侧血管变化,初步判断患者属于出血或者梗死;面瘫患者通过翳风穴压痛反应判断疾患轻重转归等。2.3主张凡病要重“调”,使之达到阴阳平衡,才能治愈疾病。临床辨证重视心肾,心者,五脏六腑之大主；肾者,,先天之本。善用内关、膻中、鸠尾调心神,肾俞、命门、太溪调理肾精。2.4重视针灸药结合,崇尚针药并用,指出针灸科医师必须针灸中药协同治疗,临床用药做到理法方药,以六经辨证为主；针灸做到理法方穴,以经络辨证为主。临床治疗胸痹、脱发、顽固性便秘等疗效显著。2.5擅长单穴治病,手针治痛。临床常以曲池穴治疗胁痛、胃腹痛；太溪治疗咽干,肾虚头痛；手针足跟穴治疗跟痛症,及灵活应用下睛明等。2.6精研内经刺法,并独创了柳刺、齿轮刺、梅花刺等特殊刺法。临床常远端取穴,上病下取或下病上取,使针感趋向于病痛部,运用金氏烧山火法,治疗瘫痪麻痹、寒湿痹痛、四肢厥冷、脘腹寒痛等病证。临症擅长刺络放血,广泛应用于各类疾患,如丹毒、湿疹、痛风,还有类风湿性关节炎,头痛,面瘫、颈椎病等。3金伯华教授诊疗经验根据“金氏针法要论”的学术思想,分析金老独特的诊疗方法及针药并行的学术特点。以金老针灸治疗类风湿性关节炎、中风、面瘫、强直性脊柱炎、抑郁症、肥胖症等疑难杂症的宝贵经验入手,通过金老独特病因病机、诊断要点,治疗要点、典型病例分析,全面介绍金老诊疗经验。4金氏华佗夹脊督脉温针灸治疗强直性脊柱炎肾虚督寒证的临床研究在继承金伯华教授治疗强直性脊柱炎临床经验基础上,运用金氏针法华佗夹脊督脉温针灸治疗强直性脊柱炎肾虚督寒证患者临床观察。目的(1)评价金氏针法华佗夹脊督脉温针灸对强直性脊柱炎肾虚督寒证的临床疗效。(2)探索金氏针刺方法及华佗夹脊穴不同定位取穴方法对强直性脊柱炎疗效差别。方法采用随机、对照、单盲的研究方法,将符合纳入标准的强直性脊柱炎肾虚督寒证门诊患者63例,按照1：1的比例,随机分为治疗组32例和对照组31例。治疗组金氏针法华佗夹脊(棘突旁开1寸)、督脉温针灸,对照组常规针法华佗夹脊穴(棘突旁开0.5寸)督脉温针灸,记录治疗前、后枕墙距、胸廓活动度、Schorber试验、脊柱痛VAS评分等；并以ASAS20、BASDAI指数、中医临床疗效评定等作为主要疗效评价指标,治疗疗程为三月,评价临床疗效。结果经过统计分析,中医临床疗效评定治疗组与对照组的总体有效率、ASAS20改善、BASDAI评分的比较,治疗组优于对照组。治疗组及对照组治疗前后比较,脊柱痛VAS评分、胸廓活动度、枕墙距、Schorber试验差异均有统计学意义；治疗前后两组间比较,脊柱痛VAS评分、胸廓活动度评分、枕墙距评分、Schorber试验评分差异有统计学意义。实验室观察指标,ESR、CRP治疗组治疗前后比较,差异有统计学意义,对照组治疗前后比较、治疗前后两组间比较,差异无统计学意义。结论本研究在继承金伯华教授“金氏针法要论”学术思想和临床经验基础上,开展随机对照研究。发现金氏针法及常规针刺法治疗强直性脊柱炎肾虚督寒证治疗前后均有疗效；金氏针法与常规刺法相比较,对BASDAI评分、ASAS20、中医临床疗效评定均有明显改善；并对各项临床观察指标如脊柱痛VAS评分、胸廓活动度评分、枕墙距评分均有统计学意义,治疗组优于对照组。实验室观察指标,ESR检查、CRP检查治疗组治疗前后比较,差异有统计学意义。通过对华佗夹脊穴古今文献分析及金老临床取穴,治疗强直性脊柱炎,遵循夹脊穴棘突旁开1寸法,扩大了临床应用范围。夹脊穴向脊柱方向斜刺45°深刺法,为深刺夹脊穴治疗督脉、膀胱经疑难杂症,“骨痹刺骨”、“针至病所”,提高临床疗效提供了取穴依据。
[Abstract]:This article is a summary of the academic thoughts and clinical experience of Professor Jin Bohua for three years. It mainly includes four aspects: Professor Jin Bohua's academic thought origin, Professor Jin Bohua's academic thoughts, Professor Jin Bohua's experience in diagnosis and treatment, and the treatment of ankylosing spondylitis by the golden Hua Tuo Jiaji's Jiaji meridian temperature acupuncture and moxibustion The clinical study of kidney deficiency and cold syndrome of the kidney.1, Professor Jin Bohua's academic origin of Professor Jin Bohua's academic thought, mainly included (1) military medical treatment, anti American aggression and aid Dynasty: the Bethune Medical School of North China military and Political University and the war wounded rescue in the Korean battlefield, and laid a solid foundation for western medicine; (2) the road of traditional Chinese medicine and famous edification: through second outpatient departments of traditional Chinese medicine and Beijing Chinese Medicine Hospital study work, absorb the golden needle Wang Leting, He Puren, Xia life and other famous acupuncture and moxibustion elite academic essence; (3) fine research classics, style unique: through traditional Chinese medicine class and four classics study class, intensive reading < Huangdi Neijing > < Shang Han theory >, < acupuncture and moxibustion >, etc., to form a unique style of acupuncture, moxibustion, and medicine. And the clinical diagnosis and treatment ideas and Jinshi acupuncture manipulation techniques. (4) combine the Chinese and western, conquer the difficulties: preside the Beijing Municipal Science and Technology Commission "85 key plan - the research on the development of the Chinese medicine development 'chpursuing Feng speed' injection acupoint injection and acupuncture and moxibustion for rheumatoid arthritis. The academic ideas of Professor Jin Bohua, the prize for scientific and technological achievements of the Bureau and the life cup of traditional medicine of the world, combined with Jin Lao "Jin's acupuncture clinical essence, < Jin Bohua's arthralgia syndrome treatment set >," Jinbo Hua of the needle altar ", and so on. According to Professor Jin Bo Hua's acupuncture and moxibustion prescription in theory and clinical practice, Jin Bohua will deepen and sublimate the academic viewpoint of golden age and innovation. The summary of sex is: "cure the source, the disease is more qi stagnation", "the diagnosis method is unique, the observation and the micro", "the key to the heart and the kidney", "the acupuncture and the medicine and the use, the complement each other", "the good use of the single point, the hand acupuncture treatment pain", "the prickly method, one's own family" and other six elements, "Jinshi needling essential theory",.2.1 is guided by the theory of < Nei Jing >. It is necessary to observe the whole concept of traditional Chinese medicine, the basic law of syndrome differentiation and treatment. It must be traced to the source. It should be traced to the source. It is considered that qi depression is a unique diagnostic method for the main pathogenesis of.2.2, and pays attention to the local diagnosis of the meridians, such as the stroke patients, the changes of the blood vessels on both sides of the sublingual lace, and the preliminary judgement that the patient belongs to bleeding or infarction. Patients with facial paralysis through Yifeng acupoint pressure pain response to judge the severity of the disease and other.2.3 main tenments to "tune" in order to achieve the balance of yin and yang to cure the disease. Clinical syndrome differentiation attaches importance to the heart and kidney, the heart, the five viscera and six organs of the main; the kidney, the innate nature. Good use of Neiguan, mutton, dove tail, Shen Shu, life gate, Tai Xi conditioning kidney essence.2.4 attention. Acupuncture and moxibustion medicine combination, advocating acupuncture and drug use, pointed out that acupuncture and moxibustion physicians must be treated with acupuncture and moxibustion in coordination with traditional Chinese medicine. The clinical medication should be rational and prescriptions, based on the syndrome differentiation of six meridians; acupuncture and moxibustion achieve the principle and method of acupuncture and meridian syndrome. The clinical treatment of chest obstruction, alopecia and intractable constipation is a significant.2.5. Acupoint treatment of hypochondriac pain, stomach abdominal pain; Tai Xi treatment of pharynx dry, kidney deficiency headache; hand acupuncture point heel acupoint treatment with pain syndrome, and flexible application of the.2.6 Jing Jing Jing Jing Jingyan method, and original special thorn method of willow thorns, gear spines, plum blossom spines and so on. The treatment of paralysis paralysis, cold dampness and arthralgia, limbs cold, abdominal cold pain, etc. is good at thorns and collaterals, widely used in various diseases, such as erysipelas, eczema, gout, rheumatoid arthritis, headache, facial paralysis, cervical spondylosis, and so on,.3 professor Jin Bohua's experience is based on the academic thought of "Jinshi needling important theory", analyzing the unique diagnosis of Jin Lao With the valuable experience of treating rheumatoid arthritis, stroke, facial paralysis, ankylosing spondylitis, depression, obesity and other difficult miscellaneous diseases, Jin Lao's unique etiological pathogenesis, diagnosis points, treatment points, typical case analysis, and general introduction of golden old diagnosis and treatment experience.4 Jinshi Hua Tuo pinch ridge are introduced. Clinical study on the treatment of ankylosing spondylitis with acupuncture and moxibustion in the treatment of ankylosing spondylitis by Professor Jin Bohua's clinical experience on the basis of clinical experience in the treatment of ankylosing spondylitis, the clinical observation of the patients with ankylosing spondylitis and kidney deficiency and cold syndrome treated with the Jinshi needle method of Hua Tuo Jiaji temperature acupuncture and moxibustion. Objective (1) to evaluate the temperature acupuncture and moxibustion of the Jinshi needle method Hua Tuo Jiaji. The clinical curative effect of ankylosing spondylitis kidney deficiency and governor cold syndrome. (2) explore the curative effect difference between Jinshi acupuncture method and Hua Tuo Jiaji acupoint different location method for ankylosing spondylitis. Method a randomized, controlled, single blind study method, 63 cases of patients with ankylosing spondylitis with kidney deficiency and governor cold syndrome, according to the standard, according to the proportion of 1:1, are followed. The treatment group was divided into 32 cases in the treatment group and 31 cases in the control group. The Hua Tuo clip (1 inches by the spinous process) in the treatment group, the warm acupuncture and moxibustion at the governor vein, the normal needle method of the Hua Tuo Jiaji point (0.5 inches by the spinous process) in the control group, were recorded before the treatment, the posterior occipital wall distance, the thoracic activity degree, the Schorber test, the spinal pain VAS score, and so on, and the ASAS20, BASDAI index, Chinese medicine, and so on. Clinical efficacy evaluation as the main evaluation index, the treatment course was March, evaluation of clinical efficacy. Results through statistical analysis, the clinical efficacy of Chinese medicine treatment group and the control group overall efficiency, ASAS20 improvement, BASDAI score comparison, the treatment group is better than the control group. The treatment group and the control group before and after the treatment of spinal pain VAS evaluation The difference between the two groups of the two groups, the spinal pain VAS score, the thoracic activity score, the occipital wall distance score and the Schorber test score were statistically significant before and after the treatment. The differences in the laboratory observation index, the ESR, CRP treatment group before and after treatment were statistically significant, and the control group was statistically significant. The control group was statistically significant. Compared before and after treatment, the difference between the two groups before and after treatment was not statistically significant. Conclusion this study carried out a randomized controlled study on the basis of the academic thought and clinical experience of Professor Jin Bohua's "Jinshi needling important theory", and found that the Jinshi needle method and conventional acupuncture treatment had curative effect before and after the treatment of ankylosing spondylitis kidney deficiency and governor cold syndrome. Compared with the conventional pricking method, the BASDAI score, ASAS20, and the clinical efficacy of traditional Chinese medicine were improved obviously, and the clinical observation indexes such as VAS score of spinal pain, the thoracic activity degree and the occipital wall distance score were statistically significant. The treatment group was superior to the control group. The test room observation index, the ESR examination, and the CRP examination group were treated before the treatment. The difference has statistical significance. Through the analysis of ancient and modern literature of Hua Tuo Jiaji acupoint and golden old clinical acupoint, the treatment of ankylosing spondylitis, followed by the method of 1 inches by the side of the spine of Jiaji point, expanded the clinical application. The method of 45 degree deep puncture to the direction of the spine to the spinal column, for the treatment of the Du Meridian with the deep stab Jiaji point, the bladder meridian, "bone arthralgia bone" "Acupuncture points to the disease" to improve clinical efficacy, provides the basis for selecting points.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R246.1;R249

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